Praxis EMR Newsletter - Winter 2011>

Dear Praxites:

I am well aware of the anxiety that has formed around the release of Praxis v5 and of the importance of ONC certification to all of you. Rest assured we are working hard to get Praxis v5 certified and in your hands as quickly as possible. Presently, we are in the testing phase, meaning that the programming of all Praxis v5 features has been completed and only debugging work remains to be done. We are that close.

As pressing and urgent as certification is, please understand that we will not sacrifice quality and usability in the rush to meet a government-imposed deadline. Nonetheless, I promise you this: Praxis v5 will attain complete EHR certification, and it will do so in time for all of you to collect the maximum incentive payments allowed for in 2011.

If anyone doubts this, it is probably because of the confusion and misinformation that surrounds how these programs actually work. For that reason, this entire issue of the Praxis Newsletter is dedicated to clearing up the EHR Incentive Programs and hopefully putting to rest any questions you may have about your ability to meet the payment requirements with Praxis EMR.

In closing, I believe it is important to point out that Praxis v5 is not about achieving certification for its own sake. It is, as all our releases have been, about giving you the power to practice the best medicine you can. While our competitors have rushed to achieve certification as quickly as possible, we never took our eye off what really matters: you. By focusing on the practicing physician who works more than 60 hours a week, who is continually stressed, who is fearful of being sued, who is thinking about the well-being of patients all the time, we have figured out what everyone else is looking for in terms of electronic medical records: the ability to report discrete data within free text. In the race to certify, no one seems to have stopped to think about how an EMR can help or actually hurt a practicing physician. We, on the other hand, never stopped thinking about it.

Praxites, what we are about to unveil is technology that will revolutionize the way medicine is practiced.

We will be announcing certification very soon on our website and via our Twitter feed and Facebook Group.

Stay tuned!

Richard M. Low, M.D.

In This Issue

• 2011: What You Should Do This Year
• Medicare: How to Get $44,000 Over Five Years
  
• Medicaid: How to Get $63,750 Over Six Years
  
• Let's Keep the Dialogue Going: The Praxis Discussion Forum

2011: What You Should Do This Year

Whether you go with the Medicare or Medicaid program, securing an incentive payment in 2011 is a two-step process: first, you must register; then, you must report attestation.

Praxites can tackle step one right away. You are not required to have certified EMR technology to register. If you wish to register now, just skip the section on EMR technology; you can go back and complete this section once Praxis v5 attains certification.

Also, note that registering now does not commit you to a reporting period right away. In fact, under the Medicare program, you can wait as long as February 29, 2012 to report attestation. To secure the maximum Medicare payment of $18,000 in 2011, you must simply demonstrate meaningful use for a continuous 90-day period (the latest you can start, therefore, is Oct. 3) and submit Medicare charges of at least $24,000 during that time.

For the Medicaid program, things are even easier. Besides meeting the program's volume threshold of 30 percent Medicaid patients, all you need to do is simply prove that you implemented certified EHR technology in 2011. Upgrading to Praxis v5 will fulfill that requirement and earn you the $21,250 payment for this year.

To sum it all up, we've prepared the following table on what you need to know for both programs for 2011:

Medicare		Medicaid
To secure your maximum payment of $18,000 in 2011, you must: Implement Praxis v.5. Demonstrate meaningful use over a 90-day period in calendar year 2011. Submit Medicare charges of at least $24,000 during that 90-day period. The attestation phase for 2011 opens this April and runs through Feb. 29, 2012. The first EHR incentive payments will be made in May 2011. Participants will receive lump sum payments.		To secure your maximum payment of $21,250 in 2011, you must: First, make sure the program is up and running in your state. Meet the program's volume threshold of 30 percent Medicaid patients. Implement Praxis v.5. Contact your state's Medicaid agency for information on the program's launch date in your state, as well as on the documentation required to demonstrate implementation of certified EHR technology and payment details.

We recommend you get started. Registration for both incentive programs is now open. To register for either, visit: https://ehrincentives.cms.gov/hitech/login.action.

You can participate in one program or the other, but not in both. You may switch once between programs after a payment has been made, but only before 2015.

Expect to receive your incentive payment four to six weeks after successfully reporting attestation.

Medicare: How to Get $44,000 Over Five Years

The federally-run Medicare EHR Incentive Program begins this year and ends in 2016. However, to secure the maximum payment of $44,000 over a five year period, you must start participating by 2012.

To be eligible for this program, you must be a:

• Doctor of medicine or osteopathy
• Doctor of oral surgery or dental medicine
• Doctor of podiatric medicine
• Doctor of optometry
• Chiropractor

The program awards incentive payments to physicians who demonstrate meaningful use of a certified EMR. The amount of the incentive for any one year is equal to 75 percent of the participant's Medicare physician fee schedule allowed charges, based on claims for services performed. The payment is capped at $18,000 the first year, and lesser amounts in subsequent years.

The table below summarizes the payment schedule and describes what you need to do to secure your incentive payment each year.

HOW TO RECEIVE $44,000 THROUGH THE MEDICARE EHR INCENTIVE PROGRAM Physicians participating in the Medicare EHR Incentive Program can earn a maximum of $44,000 over five years. To do so, they must begin participating in either 2011 or 2012.
Participation Year	What You Must Do	Incentive Payment
Year 1	Demonstrate meaningful use with Praxis v.5 and document Medicare charges of at least $24,000 over a 90-day period.	$18,000
Year 2	Demonstrate meaningful use with Praxis v.5 and document Medicare charges of at least $16,000 in calendar year.	$12,000
Year 3	Demonstrate meaningful use with Praxis v.5 and document Medicare charges of at least $10,667 in calendar year.	$8,000
Year 4	Demonstrate meaningful use with Praxis v.5 and document Medicare charges of at least $5,333 in calendar year.	$4,000
Year 5	Demonstrate meaningful use with Praxis v.5 and document Medicare charges of at least $2,667 in calendar year.	$2,000

Medicaid: How to Get $63,750 Over Six Years

The Medicaid EHR Incentive Program offers Medicaid-eligible professionals the opportunity to secure up to $63,750 in incentive payments over a six-year period. The program is administered individually by each state and territory. Therefore, the start dates, documentation requirements, and payment details vary from one state to the next.

A number of states have either begun or plan to begin the program in 2011. The following states opened registration on Jan. 3, 2011:

• Alaska
• Iowa
• Kentucky
• Louisiana
• Oklahoma
• Michigan
• Mississippi
• North Carolina
• South Carolina
• Tennessee
• Texas

In addition, California, Missouri, and North Dakota plan to open registration in February 2011. Other states will likely launch their programs during the spring and summer of 2011.

To see the estimated start-date for the program in each state, visit: https://www.cms.gov/apps/files/medicaid-HIT-sites/.
States that wish to participate must open registration no later than 2016. Regardless of when a state begins to participate, the program ends in 2021. Therefore, to secure the maximum payment of $63,750 over a six year period, you must start participating by 2016.
If the state you practice in opts out, however, you will not be able to participate in the program.

Participants in the Medicaid EHR Incentive Program should consult their state for specific information regarding attestation and payment.

Let's Keep the Dialogue Going: The Praxis Discussion Forum

Do you still have questions about the EHR Incentive Programs? If you do, you are in all likelihood not alone. The Medicare and Medicaid EHR Incentive Programs are complex and are continually being clarified. Let's keep the dialogue going. If you have a question, post it in the Praxis discussion forum and we'll do our best to find you an answer as quickly as possible.

Additionally, CMS has a lot of information on their website at: https://www.cms.gov/ehrincentiveprograms/

They have also established an excellent EHR Information Center that can be reached Monday through Friday, between 7:30am to 6:30pm Central Time at: 1-888-734-6433.

October 1, 2010

Dear Valued Clients:

In this issue of the Praxis EMR Newsletter, I would like to share with you three important announcements.

First, we have good news on the certification front. We are very close. In fact, Praxis has applied for Meaningful Use certification with the Drummond Group, an ONC-Authorized Testing and Certification Body. In the "Meaningful Use Update" that follows, you can read about the progress we are making on certification-related issues.

Secondly, we are launching a 2010 Praxis Training Webinar series. Since the success of our first training Webinar series two years ago, we have received several requests to repeat the experience. The 2010 series will kick-off on Oct. 16 with a presentation on how Praxis can help you maximize your third-party reimbursements. This webinar will be free of charge. Read more below.

Thirdly, we are launching a new program for you. Often we hear from many avid Praxis supporters offering to help us and showering us with words of encouragement. As a result, we are announcing the Friends of Praxis program. Read the feature story below to learn more. This is just a small way to thank you for all your support.

Very Best Regards,

Richard M. Low, M.D.

In This Issue

• Meaningful Use Update
  
• Praxis Training Webinars
  
• Praxis and the iPad
  
• Praxis on the Cloud
  
• Friends of Praxis Program
  
• Tricks and Tips: The Auto-Save Feature
  
• Important Reminders

Meaningful Use Update

On August 13, the U.S. Department of Health and Human Services published the testing procedures for each of the Meaningful Use certification requirements. The documentation for the 45 tests is available here:

https://xw2k.nist.gov/healthcare/use_testing/finalized_requirements.html

Clearly, programming an EMR to pass the tests will take time, and the time required is inversely proportional to the sophistication of the product. Products as complex as Praxis, with so many moving parts, have more complex interactions that have to be addressed for certification to succeed and for the product to remain user-friendly. Praxis has all the elements needed for certification; we merely need to fine tune them and successfully test. This is a matter of a few more weeks.

In fact, we have already taken preliminary steps to attain certification. In early September, the Drummond Group, an ONC-Authorized Testing and Certification Body, accepted our application for testing. This has forced us to push back our planned Praxis v5 release. Rolling out Praxis v5 at this time would place an extra burden on our development team at a time when certification must be our sole focus.

Praxis v5 will have many exciting new features, including ePrescribing as required by ARRA. However, we are most excited about Datum. This feature was discussed in detail in the previous newsletter. Datum not only fulfills the government's requirements for data transfer and interoperability, but it also has the potential to revolutionize the way medical research will be conducted. We believe that in the later stages of Meaningful Use, Datum will prove far superior to any template-based solution. In fact, we predict Meaningful Use will further expose the usability problems that are inherent in template-based systems.

In closing, we would like to clear up a misconception about Meaningful Use. There are those who are skeptical about the incentive payouts. It is worth noting that the program's funds are not taken from Medicare payments; rather, under the ARRA legislation, the money has been specifically set aside by Congress for those providers who can demonstrate Meaningful Use with a certified EMR. The money is there, waiting for you, and we are going to make sure you get your share.

Praxis Training Webinars

It is our pleasure to announce a new Praxis Training Webinar series starting on Saturday, October 16 with a free webinar on how Praxis can increase your revenues and reduce your costs.

Praxis EMR is the most powerful and advanced EMR system on the market, but many of our clients are missing out on the unique features that unlock its full potential. Praxis is living software that interacts with you, adapts to your style, and changes in step with you. It can help you improve the quality of the medicine you practice, earn you higher revenues, save you and your staff time, and improve the overall efficiency of your practice.

On Oct. 16, we invite you to join Tom Smith, Praxis Director of Education, and Steve Robinson, one of our top Praxis trainers, for an eye-opening experience.

Saturday Oct. 16, 4 pm EST: How to make more money with Praxis EMR

The Oct. 16 webinar represents the first in a 10-webinar series. Ideas for the final webinars are still being discussed. If there is a topic of special interest to you, please share it with Tom (tom.smith@praxisemr.com).

Our last Praxis Training Webinar series was held in 2008 and received excellent reviews. Don't miss out this time around. Please visit our website to register for the Oct. 16 webinar, and check the website regularly for future webinar announcements.

Praxis and the iPad

Praxis users are raving about how well Praxis EMR works with the iPad. To use Praxis on the iPad, simply connect the iPad via remote access to the workstation where your Praxis is installed. If you are using a Windows operating system, you will need a small program to make it compatible with Mac OS. Our support team is available to assist you with the setup. Contact us via online chat.

Praxis on the Cloud

Imagine being able to use Praxis EMR without requiring you to maintain a server or set up a network. Imagine further that under this arrangement, Praxis would run faster than ever before.

Welcome to cloud computing. In cloud computing, your Praxis EMR application and Oracle database reside not on a server in your office, but in a virtual space comprised of shared resources from thousands of servers and computers that is known in IT circles as "the cloud."

The cloud offers several advantages over the traditional Terminal Server configuration, including:

• Greater processing speeds.
  
  
• A uniform environment for all Praxis users. This is noteworthy because a uniform environment will cut down on technical issues and the need for technical support. Most of the reported technical problems are tied to how Praxis EMR interacts with the unique hardware and software configurations of the user. With a uniform environment, the number of technical problems will be greatly reduced and, when a problem does emerge, once we resolve it for one user on the cloud, it is fixed for all users on the cloud!
  
  
• Access to all your information is only an internet connection away. The cloud is practical for doctors on the move, since the cloud can be accessed via internet from any location. Pretty much any computer will interact well with the cloud. In addition, new products like the iPad are especially suited for the cloud environment. With the cloud, there are no hardware upgrade costs. There is merely a monthly fee for "renting" the cloud space. At Praxis, we are currently evaluating our fee structure, and are presently charging $85 per month per user with a reasonable startup fee. With time, we expect the fee to decrease significantly.
  

Cloud computing will be a great alternative for many clinics, especially those with few users.

We have successfully inaugurated our first Praxis user on the cloud. If you would like to be a cloud beta tester, please contact our technical support staff (support@praxisemr.com).

Friends of Praxis Program

Infor-Med is proud to announce the Friends of Praxis program. For 22 years, our clients have spread the zeal and excitement of Praxis' unique template-free approach to their friends and colleagues. It is only fitting, therefore, that you share in the rewards. Starting immediately, Praxis will award discounts on support fees to clients who refer friends and colleagues to us. The next time you do a fellow doctor the favor of introducing them to Praxis, do yourself a favor in return; simply let us know the name of your colleague and your account will be credited $1000 in annual support fees for each new clinic that adopts Praxis. With just a couple of successful referrals per year, you can reduce your support fees to $0. Additional referral bonuses will be applied to cover the support fees of future years.

With the Friends of Praxis program, our EMR not only helps you make more money; it saves you money, too!

Send your referrals to sales@praxisemr.com, and be sure to mention that it is a Friends of Praxis referral.

Tricks and Tips: The Auto-Save Feature

As mentioned in the last newsletter, Praxis can save the note every few minutes as you create it. This is a particularly valuable safeguard against unexpected crashes. Additionally, with the auto-save feature enabled, you do not have to worry about manually saving the note while you work, nor do you have to be concerned about stepping away from your computer in mid-note to attend to other, more pressing matters; Praxis will save your work for you automatically!

To enable the auto-save feature, follow these easy steps:

1. Click on the Settings tab on the right of your screen.
   
   
2. From the Settings screen, click on the SOAP Settings button. This will call up a pop-up window.
   
   
3. In the top left of the pop-up window, you will see the Auto Save box. Click to activate it and then specify how often you would like to have the note saved. For example, in the screen cap below, you will see 3 minutes specified.

Important Reminders

External Backups

Don't forget to backup your electronic medical records. Backing up is easy and vitally important. Failure to backup your medical records could lead to the irretrievable loss of information.

In addition, we recommend using an External Backup Service. These companies specialize in moving your data to an outside location. Healthy Server is one of the best in the business:

https://www.carroll.net/

We do not receive any direct or indirect financial compensation from Healthy Server. We hold them in high esteem based on our working experience with them, and mention them here for the sole purpose of offering guidance to our clients.

Online Chat: The Best Way to Access Customer Support

Online chat is the fastest and most efficient way to receive customer support. There is no reason for you to wait when you need help. Just start typing in the chat window and a customer service representative will be with you instantly.

Online chat is available Monday to Friday, 8am to 8pm EST. You can access online chat from the Infor-Med webpage. Click on the Clients tab in the upper right corner, and select Live Support.

From the Live Support page, just click the Live Support button.

When you do, a chat window will open. Start typing and a customer service representative will respond right away.

Explain the issue you are experiencing via chat. The customer service representative may ask you for further information. Once we have a complete understanding of the issue, our technical staff will access your computer remotely to fix the problem. In most cases, we can resolve the issue and get you up and running again in mere minutes.

You will be amazed at how quickly we can resolve technical issues by accessing your computer remotely. However, before we can do so, there are two items that should be taken care of.

The first is a legal matter. As you know, HIPAA requires that both you and Praxis EMR staff respect patient confidentiality. In order to protect yourself and ourselves legally, we must have a signed HIPAA agreement from you that authorizes us to access your computer. You may download the form here. Fill in the blanks with your information and then fax the completed form back to us at (818) 337-2158.

Secondly, you must have TeamViewer installed on your computer. TeamViewer is a remote desktop tool that we will use to connect to your computer. To download and install TeamViewer, please click here and hit run after the page has loaded. During the installation, select Company/Commercial use and enter "praxis" when prompted for the password. Please provide the ID number at the end of the TeamViewer installation to the customer service representative when you contact him or her via online chat.

Help us help you! Please use online chat whenever you experience a technical issue.

July 16, 2010

Praxis Update: Good News on Meaningful Use

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Dear Valued Clients,

With the Meaningful Use regulations finalized earlier this week by the HHS, we have much good news to share. The final rules vindicate Praxis' unique Concept Processing approach. Not only are we certain to attain certification with this new upgrade, but it is also clear to us that with these new regulations, Praxis will be the only user friendly EMR available in the market. Templates will not be able to do the job demanded by these regulations and still be user friendly.

In this newsletter, we will give you a sneak peek at the upcoming Praxis 5 release. We believe that the information contained herein will prove valuable to you as a medical practitioner; therefore, we request you read on when you can dedicate some quality time to the content that follows.

Praxis 5, Usability, and HITECH "Meaningful Use"

Praxis 5 will be released with a new look and with a host of improvements requested by so many of you over the last few years. There is much we are excited about with this release, but for now we will focus on the critical features that have the greatest impact on your practice-features relating to the upcoming Meaningful Use regulations.

The Meaningful Use regulations pose significant challenges to all existing EMRs, requiring them to expand their capabilities to meet public health goals. The suite of features developed to address the Meaningful Use requirements will change Praxis into a more powerful tool, extending its benefits and increasing your revenues.

Indeed, we are on the cusp of a major paradigm shift. Long-time Praxis clients recall the long wait that preceded the Praxis 3 release. When Praxis 3 was finally unveiled, most would agree that it represented a giant leap from our previous version (2.19). Praxis changed from a simple though intelligent charting software into a medical tool that enabled physicians to practice better medicine by constantly learning from a doctor's past experience. Indeed, this innovation has made Praxis the leader in User Satisfaction in the area of Quality Medicine (see the 2009 Survey by the American Academy of Family Physicians).

With Praxis 5, we are all about to take a larger leap.

Report on the AAFP Study of User Satisfaction published last December and every two years. With a membership of 94,000 physicians, this survey is the most authoritative of its kind, as only 10% of practicing physicians use an EMR today. We believe the Concept Processor and recommendations made by our brilliant clients contributed to Praxis' leadership in the area of quality medicine.

"Meaningful Use" and Usability

The term "usability" has been thrown around plenty these days, but it is often misunderstood by many physicians. Usability means ease of use, and it should not be confused with ease of learning. Think of it this way: It is very easy to learn to use a bicycle, but if you plan to go far, using an automobile is much easier. Most of us have probably dedicated hours to learning how to drive a car, even enrolling in Driver Ed courses to help ensure success at the DMV. With EMRs, the same principle applies; it is worth investing time to learn how to use Praxis more powerfully. If you need help, we invite you to change that today. Simply call us! We are often amazed at how some of our clients tell us how difficult Praxis is to use, whereas others in the same specialty tell us how easy and powerful it is, how much time it saves them, how it makes their lives easier, and how it improves their income and their practice of medicine. Of course, the latter take the effort to learn the program really well.

For Praxis' first 16 years, getting usability was straightforward. We would develop new software, present it to our community of Praxis users, and receive invaluable feedback. Over the years, you told us what features were not working as intended, what areas of development we should improve, and what functionality you would like to see added. Often, your feedback has opened our eyes to issues we could not think of on our own. Based on your invaluable comments, we made many modifications, and through this collaborative approach, Praxis progressively became more and more powerful. At Praxis, we take our lead from you, the physician clients who put our product to use in your practices. No self-initiated idea, no matter how brilliant, can equal a report from a client. For years, we have developed this two-way communication process, creating a virtuous feedback system where every client became a teacher, and Praxis kept getting better and better. Working as a team with you, our clients, we have developed the most powerful and usable EMR in the world.

Unfortunately, three years ago extraneous circumstances forced us to temporarily abandon this wonderfully symbiotic relationship. In 2005, the Certification Commission of Health Information Technology (CCHIT) entered the picture. The problem with CCHIT was that it positioned itself as the EHR expert without having the qualifications to do so. After all, how could anyone claim to be an expert on nascent technology that had been adopted by only a handful of physicians and used effectively in practice by fewer still?

"The system shall..."

The problem with CCHIT was its top-down approach. It issued hundreds of regulations dictating how EMRs should function based on groupthink by self-proclaimed "experts" representing different interest groups (collectively called "the EHR Stakeholders'). In essence, this was development by committee. We simply received a spreadsheet with hundreds of items that began by saying "The system shall..." It has not worked!

In an effort to maintain CCHIT certification to stay in business, we spent hundreds of hours revising Praxis to meet their requirements without sacrificing usability. Eventually, we came to the realization that adhering to CCHIT requirements would turn Praxis into an unusable product (and we in fact saw this fate befall many competing EMRs). Consequently, we let our three-year CCHIT certification lapse in January of this year (Praxis was one of the first EMRs to be certified by CCHIT in 2006, a three year certification lifespan). We simply refused to turn Praxis into a template nightmare meant to micromanage physicians.

The FEDS finally see the LIGHT!

Fortunately, we were not alone. As the new Obama administration took control of healthcare, Dr. David Blumenthal, the newly appointed National Coordinator for Health Information Technology was given a $2 billion budget and the authority to set things right. We must say, taking into consideration all novelty of the issues and the many obstacles and challenges he is facing, so far Doctor Blumenthal has done extremely well against amazing lobbying pressure from powerful interest groups.

Dr. Blumenthal comes into the picture with strong qualifications. Not only does he have an MD after his name, he actually practiced medicine for many years (surprisingly, many EHR "experts" have MD after their names, but have never practiced medicine). We strongly believe that having practiced medicine is a sine-qua-non for understanding EMRs. EMRs are not about computers, as many think; they are about medicine! And practicing medicine provides you a whole different perspective on this issue; a point CCHIT certification authorities seemed oblivious to.

Further, in addition to having practiced medicine for many years, Dr. Blumenthal actually used an EMR in his practice. In other words, he, like many of you, knows what he is talking about!

As soon as he was appointed by President Obama, Dr. Blumenthal authored a paper that appeared in the New England Journal of Medicine. That paper was the first to spotlight the critical issue of usability.[i] Noting his own disappointment with products certified by CCHIT, Dr. Blumenthal observed that many EMRs were basically not being used by physicians even after expensive purchases. It is in this article that he coined the term "Meaningful Use."

Following months of hard work, this week the HHS, under the direction of Dr. Blumenthal, released new sensible regulations to fulfill the HITECH Act requirements (https://healthcarereform.nejm.org/?p=3732&query=home). Under the new law, starting in 2011, a physician seeing Medicare or Medicaid patients is eligible to receive up to $65,000 in reimbursements to offset costs associated with the adoption of a certified EMR. This is made retroactive to all of you, who purchased your EMR already.

More importantly, certification will no longer be determined by CCHIT, but by the Feds. In fact, CCHIT has been decertified. All the regulations, plus the testing modalities for EMRs will be released by the Feds, and many are already being generated by NIST, a federal agency established for this purpose (https://xw2k.nist.gov/healthcare/use_testing/index.html).

What Does the Government Want?

The government maintains that the procurement of clinical information by the HHS will help to both improve the quality of medicine and reduce its costs. The premise is that if the government could learn about the diseases people present with, how these diseases are being treated in the real world, and how much the treatment costs, then many millions of dollars could be saved.

The theory goes on to say that quantitative statistical data generated by physicians using Electronic Medical Records could also provide critical information on best practices at the point of care. However, these are only theories. For a major challenge on these theories, we recommend an excellent article by Dr. Trisha Greenhaulgh, Tensions and Paradoxes in Electronic Patient Record Research[ii], which is currently causing a stir throughout the government and EMR industry.

What does PRAXIS want?

Our number one goal is to help you, the practicing physician. Praxis strives to help you save time, practice better medicine, reduce your personal stress, and earn a higher income. In short: we work for you and for no one else!

That being said, we do recognize some value in the government's intentions, but not what the government believes it to be. We believe that accurate information on healthcare delivery will lead to increased revenues for medical professionals. This bold statement is based on the fact that future studies will reveal, not surprisingly, that the value in healthcare derives from doctors and their staffs, not from insurance companies and their hundreds of micromanagers. As most of you know, the latter have only increased the cost of medicine by heaping on layers of unnecessary supervision, and we believe that the studies will irrefutably prove this. The data will show that there is a tremendous waste of money on issues that have nothing to do with good healthcare, such as demands created by third party payers and regulators, unnecessary requirements, and duplication of effort. With these inefficiencies exposed, one can expect to see healthcare costs reduced, freeing up funds that will be used to increase the salaries of deserving physicians and nurses.

We also believe that most physicians (certainly most of you, our bright clients) do want to practice better medicine, and would therefore welcome just-in-time information at the point of care. However, no one wants to be micromanaged by remote control. It is essential, therefore, for an EMR to enable two-way communication rather than transmit orders from above.

In short, a properly programmed EMR will meet the government's goals and, as a result, make an end-run on all the bureaucracy while empowering physicians and their staffs. Praxis 5 will make this happen.

Report on a Study of User Satisfaction of 94,000 doctors. Curiously, Praxis is the ONLY EMR in this group that does not include a billing feature within it, and yet it is still the leader in making doctors more money.

Praxis 5 has been three years in the making. It is our most ambitious upgrade to date. This upgrade will resolve the critical issue of providing coded data to third parties without driving you crazy. In the new "Meaningful Use" environment, this is a promise that the other template-based EMRs cannot deliver.

Here is why...

Praxis 5 - Datum versus Templates

The medical mind-your mind-does not think mathematically. Instead it works with personal ideas and concepts. It adapts to uncertainty, and this is vitally important in medicine, given that, as you know, human beings do not always present with clear-cut cases. A system that denies you the flexibility to express the beautiful ambiguities of medical thinking is bound to fail. Otherwise, computers could practice all by themselves! Just input the data, get checked by a machine, and out comes the diagnosis and the treatment.

Boy, wouldn't that be easy!

But, as you know, that is not how medicine works. Instead, the way you practice your specialty, whatever your specialty may be, is more a form of art than the mere application of rote formulaic solutions. As we were often warned in medical school: "Treat the patient, not the lab result!"

Of course, numbers are important, but only as information that helps guide you as you follow your personal Gestalt, learned over years of seeing similar patients and learning from them, from colleagues, and even from your own past mistakes. That is why medical students have such a hard time practicing medicine; it takes many years of experience to practice it well!

With Meaningful Use, the challenge for EMR developers is to make the numbers and the discrete data available while respecting the user's personal way of practicing medicine. For many of our competitors, the solution was simple: Let the user do all the work. Think about what that would mean to you! If you thought the Medicare Levels of Service issue was a nightmare, just wait until you see what is coming next!

Forcing physicians to select codes in order to communicate with evaluators is enough to drive any one crazy! Templates are nothing but codes with multiple pick-lists, pick-lists you have to select on your own. Who has the time? And who wants to invest the effort? Clearly, that is not why you went to medical school!

A far more user-friendly approach is needed. Enter Datum.

Datum & Concept Processing

The epiphany that led to the development of Datum flowed naturally from the theory of Concept Processing. The Concept Processing approach recognizes that we humans do not think in words or letters, but in abstract concepts that our subconscious mind turns into words. Praxis, therefore, deals not with individual words, but with text strings that communicate concepts. And what are codes and discrete data if not shorthand for concepts, as well?

At Praxis, we believe that these discrete codes and values should be afterthoughts of your clinical thinking and should never stand in the way of your practice of medicine. Accordingly, Datum will make it possible for you to easily embed a code or any other discrete data into your own personal text. The embedding need only be done initially; thereafter, Praxis will bring it up automatically and appropriately whenever you use this related text. In this way, the codes and numbers demanded by Medicare and other third party payers would generate instantly, effortlessly, and transparently.

Datum also provides an added benefit; it can reduce the level of noise you encounter daily. Noise is a critical factor in EMR usability. To illustrate this concept, Praxis for years has relied on a simple formula that many of our competitors do not seem to understand:

NOISE = DATA - INFORMATION

• Data is everything you see on your computer monitor.
  
  
• Information is the small portion of the perceived data that you are looking for in order to make your clinical decision.
  
  
• Data that is not the information you need is simply noise; it clutters up your desktop and gets in your way.
  
  

Noise slows you down, increases the chances of error, and increases personal stress. It forces your eyes to scan the monitor, to visually separate the wheat from the chaff. Why submit to this stress-inducing exercise when your computer has the power to do it for you?

Imagine a genie standing by your side and previewing all the incoming data before you see it. Also, imagine that this genie learns everything from you, and operates on the incoming data exactly as you would. Voila! Like magic, all the incoming labs, letters, biopsy reports, x-rays, and myriad of data are presented to you exactly when you wish to see them, where you wish to see them, and how you wish to see them!

That is Datum!

This is how it works. Place the Datum element within your own created text and instruct this element to "fetch" a discrete bit of data from your database. This could be a given laboratory result, a vital sign, a medication dosage, a self-created field, a mathematical operation (such as the BMI calculated form the height in feet and inches, and the weight in pounds), a result in the number of bullets found in questionnaires (such as a Zung Depression Scale), or even Levels of Service. The possibilities are endless. You embed the element only once-the first time-and thereafter Praxis automatically pulls the data whenever appropriate. To you, it appears as if the text seems to learn the current and correct values on its own.

Here is an example:

"Mary Smith presented today with a Body Mass Index of 23.6 kg/m2."

(<patient.FirstName> <Patient.LastName> presented today with a Body Mass Index of <BMI:Formula=Patient.VS.wt*0.454/((Patient.VS.height.ft*12+Patient.VS.Height.In)*2.54)squared> )

You create it once and you use it forever!

Queries, Queries, Queries

Queries can serve as powerful tools for physicians when they are done right. Here we come full circle to what the government wants. With Praxis, you will be able to learn anything about your practice by setting the right queries and operating with discrete data and Datum elements. Anyone with a bit of college math can learn to create these queries with ease and pass them on to other users or Praxis clinics. Once created, anyone can then use them without even knowing how to create them! (A great book on creating these queries is "SQL Language for Mere Mortals" by Vescas and Hernandez). In developing this aspect of Praxis 5, we came to the realization that every prospective query is a practice guideline in reverse. While other EMRs are embedding "policemen" in their templates to check on user compliance with the many new practice guidelines (to the delight of the insurance companies), Praxis employs built-in "assistants" instead. In this way, your practice will always report 100% in pay for performance painlessly and automatically. Any time you deviate from a guideline, the explanation will be generated instantly ("PAP Smear not indicated on this patient s/p hysterectomy"). Your score: 100%. Isn't this what you need? Why should this not be an open book test? Why should you not be advised at the point of care on relevant issues? This is what improving the quality of medicine should be about.

"A funny thing happened on the way to ePrescribing..."

Creating an ePrescribing interface was easy. Creating one so that it is usable was another matter.

Praxis 5 has embedded ePrescribing within the Concept Processor. But when we presented our software for certification by Surescripts (Surescripts holds the monopoly on ePrescribing in the USA), they initially denied us simply because they could not understand how Praxis works. Surescripts informed us that every drug the user prescribes should be reviewed and set individually by the user, with all its many fields, prior to sending it on to the pharmacy. Every drug, for every patient, every time.

We explained that Praxis does not work that way, that often, when selecting an assessment, the drugs appear automatically in the user's SOAP Note. Thus, after a quick review of the dosage, the user is ready to send the prescriptions forward as a batch. Surescripts turned a deaf ear, stating only that: "No one else does it that way, and so it is unacceptable."

In order to comply with their requirements rather than fight them, we spent many weeks "downgrading" the medications module so that it would function in a way that Surescripts could understand. Don't worry, though; with a click of a setting, you can turn off this "downgrade" and Praxis will again work as you expect, sending off prescriptions to the pharmacy in the background without demanding additional effort from you.

Beta Testers Wanted!

(IF YOU ALREADY SENT US YOUR REQUEST TO BE A BETA TESTER for Praxis 5, YOU ARE ALL SET)

Our success depends on your feedback. We are looking to round out the first group of beta testers to test Praxis 5 in a single user environment. You will not be able to combine your Praxis 5 with your Praxis 4 at this time; therefore, Praxis 5 will need to go on a separate computer. For those of you who helped us with Praxis 3 way back when, you know what this implies: You will be able to use your own medical knowledge base, but not your progress notes. Meanwhile, we will request your current database so we test it here to ensure that when you transfer to Praxis 5, this will not create a problem with your old data. These notes cannot be commingled with Praxis 4. Once you feel that you can safely upgrade to the network, you will let us know and we will upgrade you. You will then be in the Praxis 5 beta network.

There is no easy way to create a great EMR. We know many of you are anxious to get started, and that you would like Praxis 5 to be perfect and ready to go today, but the truth is that we won't know exactly how well it works until it is actually being used in your office. We know P5 will revolutionize medicine and that it promises to be highly user-friendly. We also know that the alternative template solutions will drive anyone crazy. What we don't know is how long it will take for Praxis 5 to available to all of you. We suspect it will be within the next 90 days.

What about the HITECH Exam for Certification?

This is an excellent question! The final Meaningful Use rules were released on July 13.. No EMR in the country is currently certified. We are certain, however, that Praxis 5 will deliver the functionality HITECH requires. Additionally, before the rules came out, we begun running tests on Praxis 5, such as the LEIKA CDA HL7 Data transfer test, and the results have been excellent.

Certification is now our number one priority. The question is not if, but rather when. We want you to receive the $65,000 (per provider) as soon as possible. However, we will not take shortcuts that compromise usability. We will keep you posted on progress in future newsletters.

For further information on certification, we offer the following articles of interest:

https://www.healthdatamanagement.com/news/rule-onc-ehr-certification-meaningful-use-40489-1.html

https://www.nytimes.com/2010/06/08/health/policy/08health.html?scp=1&sq=computerized%20records&st=cse

https://www.fierceemr.com/story/cms-well-publish-our-meaningful-use-final-rule-july-14/2010-07-01

https://www.fierceemr.com/story/blumenthal-certified-ehrs-should-be-available-fall/2010-06-24?utm_medium=nl&utm_source=internal

https://www.healthdatamanagement.com/news/rule-onc-ehr-certification-meaningful-use-40489-1.html

https://www.fierceemr.com/story/blumenthal-certified-ehrs-should-be-available-fall/2010-06-24?utm_medium=nl&utm_source=internal

https://www.fierceemr.com/story/cms-well-publish-our-meaningful-use-final-rule-july-14/2010-07-01

https://www.emrandhipaa.com/emr-and-hipaa/2009/12/24/is-your-emr-stimulus-ready/

https://www.emrandhipaa.com/emr-and-hipaa/2009/12/07/two-emr-stimulus-questions/

https://healthcarereform.nejm.org/?p=3732&query=home

Praxis 5- Many other features

Today, we focused our newsletter on Meaningful Use. However, Praxis 5 includes many other improvements requested by many of you over the past three years. We decided to place them in this product and not to delay development any longer. There are a great deal of new features that will make your life easier. We will describe them in future newsletters and Webinars in the coming weeks.

By the way. DID YOU KNOW THAT NOW PRAXIS SAVES THE NOTE EVERY FEW MINUTES AS YOU CREATE IT? We will tell you more about this in our next newsletter. This one is getting way too long!

Please share your thoughts with us. Change always brings about anxiety, but we are excited by what's to come in the practice of medicine. We want to be by your side as it happens!

Very Best Regards,

Richard M. Low, MD
CEO

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[i] "ONCHIT currently contracts with a private organization, the Certification Commission for Health Information Technology, to certify EHRs as having the basic capabilities the federal government believes they need. But many certified EHRs are neither user-friendly nor designed to meet HITECH's ambitious goal of improving quality and efficiency in the health care system" Blumenthal, David, Stimulating the Adoption of Health Information Technology, NEJM Volume 360:1477-1479, April 2009

[ii] Trisha Greenhaulgh, Henry W.W. Potts, Geoff Wong, Pippa Bark, and Deborah Swinglehurst (University College London), Milbank Quarterly, 87(4), 2009

Dear Praxis Clients,

We are excited to announce the initial release of Praxis 5 in single user mode to existing clients who wish to beta test it.  As a beta tester, you will be able to provide us with  valuable information on the usability of Praxis 5, and contribute to its refined performance.

Praxis 5 is compatible with Praxis 4, but it is enriched with several important new features that make it revolutionary. Praxis 4 users will be able to test these features without affecting their work or procedures one bit. 

Datum

A major improvement to our software is the introduction of DATUM, which will allow you to embed discrete data within free text. To understand the importance of DATUM to medicine, you should know that many in the field of Health Information Technology expect doctors to write in discrete data jargon rather than normal English. We think they are crazy!

DATUM allows you to use your own words when documenting your work, while enabling you, and the rest of the world, to obtain discrete data required for analysis, flowcharting, query and interoperability. In this manner, Praxis Version 5 becomes a “Qualified EHR” for purposes of meaningful use so that you can get paid for using it. (Please see and critique the attached Datum White Paper beta testers are the first ones to see it prior to its release to the world).

The new Praxis DataMiner

This new feature will allow anyone with minimal training in SQL Language programming to query your Praxis database. Furthermore, developed queries can be shared with other clinics that use Praxis. Indeed, we expect several clients to create very sophisticated queries to be shared with the rest of our clients. With your help as a beta tester, so will we (you tell us what you need, and we develop it for you at no charge during the beta period).

E-Prescribing

This feature allows your prescriptions to be transmitted to the pharmacy of your choice electronically. It interfaces with Surescript™, which currently holds the monopoly on the American market in e-prescribing. There is NO other company that can interface with pharmacies, and all vendors must interface with them. We are currently in the final phases of testing the engine, and now it will be your turn as beta testers.

Praxcoder

This feature allows for automatic “Level of Service” advice and documentation. It works backwards. First, it discloses the optimal Level of Service based on your Procedures, Diagnoses and Plan Elements. Then, it will advise you on the necessary level of H&P that meets this optimal expected Level of Service. This engine takes into account the amount of time spent with your patient, if it helps raise the Level.

External Hyperlinking

Praxis 5 allows you to hyperlink any document existing outside of Praxis for instant access and future review. The only requirement is that the document in question not be moved from the area being pointed to. You may hyperlink to any kind of file including graphics (perfect for Ophthalmology and Dermatology), Excel files (think of the flowcharts you can create), external X-Ray DICOM images, external sound or video files, and any other type of file.  Your imagination is the limit. If you place these files in areas such as PSI or Chronic Objective finding, then the documents will appear every time you open your patient records…instantly.

Laboratory References

The system will track any orders, including labs, and link the results with the original order.  When you order a lab, for example, it will decrease errors by sending the order electronically, and then wait for the results. If the results do not return in the period you established, it will warn you. If they do return, it will link the order to the results. Viewing the results will show you the original note where it was ordered. Looking at the previous encounter’s order, the system will lead you to the result instantly.

New Vaccinations Module

Praxis 5 includes a module for vaccines that meets all requirements, including the new requirements for interoperability, Pediatrics, and Family Practice.

Double Signature

for use with Physician-Extenders in States where required Praxis 5 is meant to pass any requirements set by the government to qualify for “meaningful use.” According to the American Recovery and Reinvestment Act (ARRA) legislation, which will reimburse you for using a certified EMR.

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Please let us know if you would like to beta-test this upgrade. Your initial beta will not demand that you upgrade your current Praxis. You can still use your Praxis daily, but you can start playing with the features of Praxis 5 and thereupon share your views with us . This is the optimal time for us to change and improve the new upgrade.

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New Physician Advisory Panel

Our company successfully meets practitioners’ needs through a constant dialogue with our software users.  Without your input we would be unable to create products that make your workdays more efficient and uncomplicated. The release of Praxis 5 is an ideal opportunity for us to invite you to join our new Physician Advisory Panel. Because you already have Praxis 5, you are in a perfect position to educate our company.  Your critical input regarding our product’s features would allow us to make Praxis even more effective. 

Panelists would have electronic contact with me on a monthly/semi-monthly basis for a 1-2 hour session via Webinar.  Membership is restricted to providers and office personnel who are beta testers of Praxis 5.  Those who give their time to the panel will continue to be able to use Praxis 4 while testing Praxis 5. 

Praxis 5 Beta - Requirements

1. As was the case with our beta release of Praxis 3, you will need to sign a non disclosure agreement with us. This agreement allows you to discuss Praxis openly with anyone, but not to show the product to persons not connected with the project. 
2. You will need a separate workstation until we are able to upgrade you to the network. This will happen after you and our software designers ascertain that the product is stable enough to do so.
3. We would like you to provide us frequent feedback, and try all the new features as much as possible.

You will still use your current Praxis for day-to-day operations until the new upgrade is safe enough to be used in the network version.

We pledge to work very closely with our beta testers to ensure that the new product surpasses client expectations.

IF YOU WISH TO PARTICIPATE, SIMPLY REPLY TO THIS EMAIL WITH THE COMMENT: ”YES”
 
I wish you continuing success with Praxis. This is as much your product as it is ours, and with your support, it will continue to evolve to set our industry’s benchmarks.  I thank you for your continued support, and look forward to working with you.

Richard M. Low, MD
CEO Sunday, October 4, 2009


Dear Praxis Clients,

Praxis 5 is about to be released in beta. We thank those of you who have decided to participate in this early part of the release. Together, we will not only come out with a great product, but we will chart the directions that Praxis EMR will take the next releases.  Praxis as a product has been the result of wonderful feedback from brilliant clients who honor us by not only using the product, but sharing your ideas with us. Thank you. If you decide to join this project, simply let us know.
Here we present to you some important news.

• Improvements on the last releases
• Upgrades are Free of Charge
• Backup Issues – CRITICAL INFORMATION
• Backup: Incremental Backup Option
• Speed and Crashes
• New Natural Language Query Engine Study: Beta Sites Wanted!
• New Natural Language Query Engine Study: What is it
• New Natural Language Query Engine Study: Now comes Praxis!
• New Natural Language Query Engine Study: How will this all work?
• How to Obtain Support Fast and Effectively: Online Chat
• Team Viewer is an IV line to your system!
• Tell us How to Improve Support
• HIPAA Agreement should be done at once: IT IS THE LAW!
• Steven Gold, MD, The Magic of Praxis,: The first primer written by an actual user of an EMR!
• Life after CCHIT
• Cloud Computing
• Patient Portal – Why not simply interface?
• ICD-10
• INFOR-MED CORPORATION: Reaching Out to Potential Investors!
• Conclusion

Improvements on the Last Releases
Praxis 4 has had a gradual, but systematic improvement since its released more than a year ago.  All new features and requests, however, have been placed in Praxis 5. So when you finally upgrade to Praxis 5 you will find some very pleasant surprises, including a new and improved laboratory inbox that links all the labs in one single page for fast reading and eprescribing; and, of course, DATUM, a revolution in the Praxis EMR.

Upgrades are Free of Charge
If you are not currently on version 22 or 23, you should be in one of the two.  If you are still using version 3.6, we must warn you that upgrading may not be easy at this late stage.  In any case, please contact us as soon as possible.
Please remember that all your major and minor upgrades are free of charge. The reason to upgrade is that often a problem you may be having is resolved in the upgrade.  More importantly, we cannot fix old versions; no one can.  The solution for an old version problem is to upgrade you. If the problem persists with the new version, then we will fix it for you and for everyone else. Most importantly, fixing errors is very similar to making a diagnosis.  By having everyone in the latest version, this process becomes far simpler than trying to recall what problems belong to which version. 

Backup Issues – CRITICAL INFORMATION
From the very first time that you begin using an EMR, backup should be your number one priority. There are two ways to learn about backup: The very easy way­NOW­or the very painful way, when disaster happens. Eventually, everyone learns how to back up. Please learn before disaster happens to you!

The backup issue is always the same: not giving your simple backup procedures proper attention.  Commonly, the whole issue is delegated to an outside technician, who may not read our Technical Manual.  Backing up is extremely easy if proper procedures are followed.

LOSS OF DATA THROUGH HARDWARE OR SOFTARE IS TO BE EXPECTED. THESE ARE NOT PAPER RECORDS, AND THE ONLY SOLUTION TO PREVENT LOSS OF CRITICAL INFORMATION IS TO HAVE A GOOD BACKUP SYSTEM IN PLACE.

We will be happy to both advise and review your system. Don’t get caught off guard with an inappropriate backup system. When you need it, it simply HAS TO WORK! Please spend a few minutes supervising personally the whole backup system.
We have mentioned this repeatedly in our contracts, in the first page of our manuals, and in many newsletters. But, loss of data still happens. THIS SHOULD NOT BE SO! Please review your backup system! It may be inoperative. We will help you.

Backup: Incremental Backup Option
Clients are often concerned by the size increase of the Praxis database, particularly in larger clinics. This is not a serious issue. – just think about YouTube and how they accept videos from millions of people... all for free! Storage of data has become surprisingly inexpensive. In addition, the Oracle Database is made to handle large amounts of data without loss of effectiveness or speed. Of course, you should have appropriate storage space, and RAID 10 or RAID 01 hardrive controllers are strongly recommended.

However, the issue is the time it takes to perform a physical cold backup on larger databases. Clearly, the larger your database, the slower this process becomes. It may take hours. The solution is the incremental backup.  Unlike a the cold backup, in this process only the information placed or changed after the last backup is saved. It is fast. It works in the background and it can restore data from up to the last minute before a potential crash takes place. Because only the latest information is backed up, the process time is minimal, and this allows for offsite backups via the Internet.

Oracle includes a very powerful and sophisticated method to perform these kinds of backups through an application known as R-Man.  However, supporting it also requires special expertise (an Oracle DBA is required).

A free alternative is to purchase the Veritas Oracle Backup Option, which automates the same performance without need for a DBA to monitor. The incremental backup allows for transfer of data to many outside storage systems.

Our support team will be happy to advise you on its use.

Note:  an incremental backup is NEVER a substitute for a full backup, but it makes a full backup far less frequent. You should establish a policy of periodic full backups in addition to performing incremental ones.

NOTE: IN REGARDS TO COMPANIES THAT PERFORM OUTSIDE BACKUPS, WE  DO NOT PRESENTLY RECOMMEND ANY PARTICULAR SITE. KEEP IN MIND THAT YOUR SELECTION OF AN OUTSIDE STORAGE CENTER IS ABSOLUTELY CRITICALTO YOUR PRACTICE. If you are not sure, keep your backups in a secure place.

Speed and Crashes
This year Praxis has significantly improved its speed, especially for large clinics, by discovering a flaw in the Praxis Queries that made the program go into a loop, and pinged the server thousands of times a minute.  This becomes a problem as more and more users log on.  The removal of this universal ping has made a few windows not refresh properly. If you find such a problem, please let us know and we will fix it immediately. Please be aware that your hardware should conform to our published specifications.

www.praxisemr.com/system_requirements
 
If you have speed issues or frequent crashes, FIRST check to see whether you have the correct hardware.  We have noted that most problems can be solved with a minimal expense to you, while a small item that is below specifications will slow down your entire network. The main culprits are:

1. Not using RAID 10 or RAID 01 in the servers
   
   
2. Not using at least 4 Giga of Random Access Memory (RAM) in the Servers
   
   
3. Not using an acceptable, proper server
   
   
4. Having workstations’ memory below par (i.e. RAM below 1 Giga).  Checking this is easy: right click on the “my computer” icon, go to “properties,” and read how much RAM is displayed.
   
   
5. Not handling the terminal services-type configuration in a separate server when used.
   
   
6. Wireless connections need to be checked by an expert. The antenna of the wireless server has to be checked to ensure that it reaches wherever you will be using the workstations.

The unfortunate problem is that any of these issues are typically perceived as “Praxis is not working; it runs slowly and crashes all the time.”  Praxis will work well if your computers have the appropriate hardware and configuration.

Please test your system as follows: Open the application window or a patient record.  If doing either takes more than 6 seconds, and/or your system crashes from time to time, equipment is likely to be blamed.

Keep in mind that our team can “see” most, but not all, problems with your hardware. If we cannot see the problem with your hardware, we will recommend a Cisco certified technician (if you don’t already have one). The issues may be varied.  In one instance, a large clinic with many crashes and slowdowns was found to have an ineffective RAID controller.  We could not visualize the problem via the Internet from our end. The hardware threw a red light, but the local technician did not realize its meaning. An expert CISCO trained specialist was sent who immediately diagnosed the malfunction of the RAID controller. Replacing the RAID controller solved the issue and the system began to run fast. Up to that moment, however, Praxis had been blamed as the culprit.

New Natural Language Query Engine Study: Beta Sites Wanted!
Praxis needs your help for a fascinating study being conducted by Praxis and the NYU on Natural Language parsing and query:

https://www.cs.nyu.edu/cs/projects/lsp/
https://cs.nyu.edu/~nhan/fcompling.html
https://mlp-xml.sourceforge.net/words/ahie_20000801.html
https://mlp-xml.sourceforge.net/words/Med_kB_lex.html
 
As you know, Praxis is the only EMR in the market that does not use templates.  The entire medical software industry, having templates in place, began to push hard for the implementation of discrete data language, using hidden codes that purport to accurately describe the reality of the medical exchange. Today, most people in the healthcare industry back this idea. Most people, that is, except physicians for whom the whole things sounds (and is) crazy!

Behind the idea of the codes is that doctors should no longer use the English language to communicate because it literally “does not compute,” – that is, computers cannot understand the implicit vagaries of the English language. Instead, the templates already in place are being retrofitted to hidden codes that would then make the text both interoperable with similar templated software, and also queriable by third parties. Never mind that this has never been proven to work, or that it is not practical, or even useful. The fact is, there is a pile of money behind the proponents of this idea.

New Natural Language Query Engine Study: What is it
Doctor Wheeler joined Naomi Sager, Ph.D, at the University of New York. Doctor Sager is a renowned semanticist who had been working with the issue of understanding natural language. They were joined by the brilliant programmer, Doctor Ngô Thanh Nhàn and together they developed the Linguistic String Project, a Medical Language Processor. 

The idea of this processor is very different than the insanity of the embedded hidden codes proposed by others in the industry. The idea is to mimic the way the human mind READS free text and makes sense of it, rather than forcing providers to conform to a highly constricted standard of expression, while struggling to find the codes to express medical perception and action.

Doctors Wheeler, Sager and Nhan nailed the problem, and developed an engine that steers clear of these constrictions.   For instance, if you pose a query, the engine searches within free text from thousands, if not millions, of patient records and finds your answers. This free text could be found in dictations, typings, text produced by speech recognition software, and OF COURSE, IN PRAXIS EMR (but not in the other templated EMRs).

New Natural Language Query Engine Study: How will this all work?
Just like we at Praxis did not know about their research, they did not know about Praxis.  It was Langden Bain, Ph.D, ex Chief Information Officer at Duke University Medical Center, who found Praxis and immediately brought us together. They needed an EMR that used free text, rather than templates, to test their engine. Praxis is the only one!!

And that is how this relationship started. Now, it is your turn to join this endeavor!

The research plan of the NYU Natural Language Parser is simple. We need a few clients to work with us, and share with us five real cases each (long ones, preferably). This should be done via printing into Adobe Acrobat Writer.

We will immediately de-identify the data for HIPAA purposes (if you have not done so yourself) so that only a number remains We will then forward the documents to the team at NYU.

Please also send us 5 questions you may have regarding the data you submitted. We will sort all participants’ questions, and the full compilation will return to you and the other physicians in the study.

The team at NYU will pull your combined questions and send us (and you) their response.

You can help us decide how accurate this parser engine is! Very straightforward, don’t you agree? If this project is a success, we will incorporate it into Praxis for all to use.

Our technical support team will help you with the necessary setup.

We postulate that this experiment will debunk the use of structured language in favor of normal English. We strongly believe that the queries thus performed will be far more accurate than those that purport to read artificial and hidden codes, but which in reality askew the dataentry in favor of expediency. This experiment will be most useful, and we will of course give you full credit for participating in this research with us.

Would you let us know if you are interested in participating?

How to Obtain Support Fast and Effectively: Online Chat
Today, the phone has become almost obsolete. Still, some of the staff in your clinic is not aware of the online chat and use the phone, perhaps thinking that you will receive better or faster service. Phone conversations go unmonitored, and may be subject to poor interpretation. Furthermore, phone calls do not receive priority –most often they go into voicemail. 

With online chat everything is addressed instantly the average time to reach a human customer rep is approximately 6 seconds.  (This is faster than would be dialing the same human on the phone) . The difference between online chat and phone calls is that no single person is tied up on our end OR YOUR END for more than a few seconds. Phone demands that both parties WAIT for communication to happen.

Also, everything you write is automatically recorded and monitored. Full accountability on our end ensures that when you have a problem, we will address it appropriately and fast.

If necessary, our tech will call you on the phone if, for some reason, things are not clear on the chat (you should have a direct phone number or cellular available). Within a few minutes of your call, the technician will access your machine and fix the problem via “TeamViewer.”

Thus, the best and easiest way to obtain any kind of support from Praxis is to go to your workstation desktop and add  the following hyperlink:

www.praxisemr.com/livesupport
 
Clicking on the above link will get you a HUMAN Praxis Support Specialist within fifteen seconds (six seconds average)! So please, please, DO NOT USE THE PHONE FOR SUPPORT.

Team Viewer is an IV line to your system!
The access to your system is almost instant, and so is the fixing.
You will only experience a delay the very first time you use our support, when Team Viewer is installed in your system for the first time. From then on out, the link is almost instant.

YOU SHOULD ALWAYS REQUEST A TICKET NUMBER FROM US. This insures that your request is entered into our cue, and, in addition, can be provided to us to very quickly address any of your future questions regarding your request.  

Tell us How to Improve Support
How are we doing?  We would like to hear from you.  Currently, we are working  on improving the way we provide you with feedback of what is going on after you place your support request.  We will soon include in your chat area your ticket number the current work on it up to date.

In the meantime, online chat and your ticket number will give you instant feedback.

HIPAA Agreement should be done at once: IT IS THE LAW!
This is simple bureaucratic step covers both your clinic and us from handling confidential patient information.

1. Please download this document:
   Download your Business Associate Agreement
   
   
2. Execute and FAX it back to us to the number indicated in the document.
   
   
3. Keep the copy with your HIPAA documents.

That’s it! Simple. 

We will stop giving support if this document is not signed. It protects both you and us.

Steven Gold, MD, MPH, The Magic of Praxis,: The first primer written by an actual user of an EMR!
This book is a must for any new provider user in your clinic.  Doctor Gold is an expert in teaching other colleagues in his practice to use Praxis. He loves Praxis so much that he wrote a book about it. He feels strongly that the major issue with Praxis is teaching it properly­therefore, he wrote this book. It is short, very interesting, and will give a new user the flavor of how Praxis works and what it can do. We highly recommend it.

The Magic of Praxis
 
Life after CCHIT
The Certification Commission of Health Information Technology (CCHIT) mandated many features of questionable value to our clients, but which, we are required to continue certifying.  Now, we are finally back to doing what we do best: listen to you, our great clients, and solve the issues that are important to you.

After this 2011 certification is completed , several of our projects will be immediately brought to fruition:

• Patient Portal and Patient Kiosk (they are quite similar.. the former is on the web, and the latter is in your waiting room)
  
• Addressing dozens of requests from you.
  
• Moving Praxis to SQL Server in addition to Oracle
  
• Moving Praxis to the clouds to allow for outsourcing your Praxis server. (With cloud computing, web-type EMRs become obsolete as all EMRs can be placed on the web)

Cloud Computing
This most amazing development that blurs the difference between web based systems and client server systems, having the advantages of both.

With Cloud Computing, Praxis will have the following advantages in addition to all its current features:

1. No worries about hardware, maintenance, and support
   
2. Significantly faster product with lesser products (our support team watches one single Praxis around the clock… all the others would have to work equally well as they are all sitting in the same cloud). A new installation can be done in seconds. On your end, you can run it wherever you wish and with whatever machines you have without any loss in performance (you need to be connected to the Internet).
   
3. Presence everywhere there is an Internet connection.
   
4. You can keep a backup of your database in your office if you wish.

Praxis was tested in the clouds and found to work even better than as a client server system, and faster. Soon we will have the system operating and offer it to you and too all new clients as an alternative.  We will keep you abreast of this development.

For information on this exciting new technology, please look at these sites:

https://www.youtube.com/watch?v=6PNuQHUiV3Q
https://www.youtube.com/watch?v=QJncFirhjPg&NR=1
 
Patient Portal – Why not simply interface?
Questions regarding interfacing to your favorite patient portal recurrently arrive at our offices.   Many of you asked us why we don’t “simply” interface Praxis to many of the portals already in the market, believing perhaps that doing this interface would be simpler than “re-inventing the wheel.”

Actually, the opposite is the case!

The reason is simple. The difficult part of creating a portal is the interface itself.  The interface addresses the ability to translate what is currently found in the Praxis database to information that may be shown in a portal, in a way that can be properly seen. The interface needs to show information, exactly where and when it needs to be shown. The actual “look and feel” of the portal, as well as the connection through the Internet, is quite easy to resolve.   In just a few days. In fact, because we are not dealing with another company, it is far easier for us to create the portal ourselves and interface to it directly.

Furthermore, we looked at many different portals in the market and found them wanting. At issue is that none of them could use the Praxis Concept Processor to place exactly what physicians wish their patients to see in the portal (depending on the different assessments the patient may have). Said in another way, we plan to add the “Portal” and “Kiosk” Elements right into the SOAP Note similarly to how the Health Maintenance element is there today. Thus, you will be able to create special flowcharts, questionnaires, and instructions to patients; link them to a given assessment; and drop them in the Portal element in your SOAP Note, and presto, it will appear in the Portal or Kiosk. This will be exactly what your patient will see. Next time you see a different patient with the same problems, they will see the same flowcharts, questionnaires, and information depending on the assessments you’ve selected for them. The flowcharts, of course, will carry any combination of laboratory studies, vital signs, and clinical parameters and medications as you see fit. This will reduce the “noise” of your communication with your patients.

Your patients will also be able to edit their demographic information (to be reviewed by you or your assistant before acceptance), and their allergies and current medications (also pending your review). Finally, the system will allow your agents to be sent to the patient via the portal you generate an agent for the patient, the portal sends an e-mail saying the patient has a message from you, the patient clicks on the hyperlink found in the email using a unique password you have previously provided, and opens the portal to read the note and respond to it. The response gets converted into an agent, and, as usual, you decide whether it goes to the chart or not.

Because no other outside system even dreams of the association to the concept processor, none of this could be done without building our own Praxis Patient Portal.

ICD-10
The ICD-10 has been installed in Praxis for use by our off-shore client users without any problems. The transfer of ICD-9 to ICD-10 information to minimize re-linkage is something we will investigate in the next few months.

INFOR-MED CORPORATION: Reaching Out to Potential Investors!
The following  is published solely for informational purposes and is not, and should not be, construed as an offer, or a solicitation of an offer, to buy or sell any securities. Such solicitation can only be made to accredited investors via a private placement memorandum. If you believe you qualify as an accredited investor, please let us know and we will contact you separately.

To further the growth of our product and our company, and to take the amazing opportunity appearing in the HealthCare IT market today, it will be necessary to set up a strong marketing and sales organization for which we need to secure capital. We will provide our current clients, who qualify as accredited investors, the first chance to invest with us.

For further information, please contact me at richard.low@praxisemr.com and I will send you a form to establish your accredited investor status as required by Federal Regulations before we can present any solicitation.

Conclusion
Over the last three years our company has been challenged with the issues of certification.   In order to develop software we need sales, and in order to get sales we need certifications. Although our certification is not as important an issue to Praxis users except that it diverts us from developing features that are important to you, we are glad to report that with this last certification we will be able to focus on issues that are relevant to you once again. 

We are listening to you, and once this certification is completed, Praxis 5 will continue to make the software ever more powerful, more user friendly, and faster.

Thank you for for being such great clients!

Richard M. Low, MD
CEO
Infor-Med Corporation

March 17, 2007

Dear Praxis Clients,

Please open the important PDF file: Newsletter_March_17_2007.pdf

Very Best Regards,

Richard M. Low, MD
CEO

Keeping the noise down is critical, being very careful to weigh each “requirement”. Unfortunately, many physicians, IPA’s, Hospitals, and Medical Societies, listen seriously to all that hogwash.

Much more serious is to find out who is really behind these requirements. Unfortunately, Medical Societies are being run by folks who mean well, but who have little if any experience in Electronic Medical Records, nor do they understand the detrimental implications of many of the requirements to their own membership. They simply listen to the pundits and “pseudo experts” mentioned above rather than to you, the real users of Electronic Medical Records. Insurance companies, on the other hand, are far more savvy, and have a major stake in insuring that the winning EMRs represent their interests: Lowering their costs through better micro-management of your practice and lowering of your fees. LET’S NOT ALLOW THIS TO HAPPEN!

We take the STRONG position that an EMR should be first, second and third a tool for you, the practicing physician. Millions of dollars are being spent by insurance companies to ensure that the “healthcare record or EHR” (note the not-too-subtle change in the name) is a tool for them instead. The Stark Laws have been amended to allow the insurance companies to underwrite the “giving” of free or near free EHR’s to doctors, but no one has stopped to think of why,

Through well-known proxy organizations, they are promoting those EMR’s who allow ways to administer this control. We are very much in favor of practice guidelines and queries- and Praxis has the best out there-but only if and when they benefit you, your patients, and your pocketbook. We realize that we could probably do far better financially if we sided with the insurance companiese, but this is not what we or Praxis are about.

However you need to make sure that interfacing remains open and almost free of charge to you and other providers. We know that many billing companies, particularly those that have inferior EMR’s, are pricing their interfaces outrageously in an obvious attempt to force their clients to switch.

That is why it is so very critical that you educate your colleagues on what is going on. Believe it or not, you most likely know far more about Electronic Medical Records than 95% of physicians out there, let alone medical societies. You need to help educate them both. An EMR is never neutral, it takes sides, and the grave risk is that if the EMR takes the side of the insurance companies and hospitals and IPA’s do not realize the interface cost trap, you and your colleagues may become more enslaved than liberated in the decisions that are made through these new Trojan Horses.

We are starting a strong marketing campaign on this very subject, and we hope you can help us spread the good word to your colleagues. Remember, we cannot develop software in a vacuum. To develop faster and better, and to provide better support, depends on great word of mouth.

Thank you for being such great clients!

HAPPY NEW YEAR TO YOU AND YOUR STAFF!


Richard M Low, MD
CEO

ATTENTION: THOSE OF YOU WHO ARE JOINING US IN VIRGINIA NEXT WEEK. Make sure you download this latest early release version, which is the one we will be teaching with. I am really looking forward to meeting you personally!

Dear Praxis 3.3 Clients,
(If you already have Praxis 3.4 running, ignore these directions. You are all set!)

HAPPY HOLIDAYS FROM THE ENTIRE PRAXIS FAMILY!

We are all set to release version 3.4 to you. Praxis 3.4 is more stable and has been significantly improved from version 3.3 with some wonderful added features (see below).

------------------------------------
HOW TO UPGRADE

You will see that the ONLINE UPDATE button is turned on in each workstation, HOWEVER:

1. Always backup first

2. Close Praxis everywhere. Close Scanaway

3. Go to the server and in Program Files, select the ONLINE Update feature.

4. Each workstation will then upgrade automatically as you open Praxis. Please advise users that the first time may take a couple of minutes.

5. IF AND ONLY IF Scanaway does not work after the upgrade, go to www.praxisemr.com/build and download the latest Scanaway patch. (The old Scanaway will not be compatible with version 3.4, but in most cases, the update will also work on Scanaway.)

As always, our support team is available to help you with any problems at (818) 592-2900. Please avoid doing upgrades over this three-day weekend.

------------------------------------
MANUALS UP TO DATE

Keep in mind that the manuals are up to date on our website. In addition, you will find the 3.4 Mini-manuals that focus on the new features included in this upgrade. As you know, this is the CCHIT upgrade and involves some important changes as demanded by the CCHIT agency that accredited Praxis.

------------------------------------
DATE WARNING
This warning will automatically disappear upon upgrading.


------------------------------------
MEDICATIONS AND ALLERGY LINKER APPLICATION

Download from www.praxisemr.com/build


This is a very fast and effective application used to re-link your allergies and medications to the Fastcoder database so that you can perform drug contraindications warnings and queries. The use of this application is not even required because you can link the drugs and allergies as you use Praxis. It is simply a faster and easier way to link the drugs and allergies. Please see the attached short PDF file that explains its functions in detail.

------------------------------------
ATTENTION ALL PRAXIS CLIENTS--VERSION 3.5 IS COMING UP!

We are a few days away from releasing version 3.5 to you, in Early Release. As usual, participating in this upgrade is your choice. Version 3.5 has many new improvements that follow your critiques, with several exciting new features. Unlike version 3.4, first released with major re-engineering required by CCHIT, version 3.5 appears to be quite stable.

We will release our Minimanual and upgrade the User Manual prior to the version 3.5 update. If you open Praxis and see Early Release on your version you are all set to receive it once it becomes available.

If you do not wish to participate in Early Release, simply go to www.praxisemr.com/build and download the PrxOnlineUpdateFalse.reg application to your server. Then execute it in your server and all workstations.

On the other hand, if you do wish to receive the 3.5 when it becomes available in early release, and do not see the EARLY RELEASE message in your Praxis Password Window, simply download and execute the PrxOnlineUpdateTrue.reg file.

If you are a new client, you may choose to stay with Praxis 3.4 until we release the 3.5 to you later on once used by our Early Release Praxis clients. We hope that this will happen just a few days later.

Again, our entire Praxis teams wishes you, your family and your staff the very best for this Holiday Season. Keep your critiques coming. With your fantastic feedback, Praxis will only continue to get better. THIS IS YOUR SOFTWARE!

Warmest Regards,

Richard M. Low, MD
CEO

Version 3.4 Mini-manual also available now: www.praxisemr.com/build

We strongly recommend reviewing the Mini-manual prior to upgrading to this exciting new version.

New Technical Manual for version 3.4: will be available from Monday

Full User Manual for version 3.4: will be available in just a few days

Some of the major new features include:

1. Revolutionary Nursing Task Agents
2. The most powerful Clinical Practice Guideline engine
3. Improved Queries
4. Increased speed
5. Brand New Drug Contraindication Database
6. Significantly improved Medications and automatic faxing
7. Link to External Knowledge Documents
8. Constantly Updating and improved Drug Contraindication Software
9. New Electronic Signature with Amendment Capabilities
10. Printing ability for all PSI, Questionnaires, Problem List, Current Medications, and any Patient Specific Information Protocols (e.g. Vaccinations).
11. Improved Growth Charts
12. Updated HIPAA Engine, with logs and higher levels of security
13. Semi automatic faxing of all other documents
14. Improved Interfaces

And many, many small improvements that will make a big difference in your use of Praxis

….plus many fixes that you have reported that will improve your experience with your product.

MAKE SURE TO DO A BACKUP BEFORE PERFORMING ANY UPDATES!!!!

----------------------------------------------------------------------------------




Saturday, September 23, 2006


Dear Clients,

It is with immense pleasure that we release to you Praxis version 3.4, our CCHIT Certified Version.

We are very thankful to all those clinics who have used Praxis 3.4 in its early format helping us to comply with the CCHIT regulations and bringing us such vital feedback to improve it much further to the stability of today. The enormous re-engineering implicit in moving Praxis into that exclusive category of certified products while maintaining its excellence as a physician-driven EMR delayed the release to you by several more weeks. IT IS NOW READY FOR THE EARLY RELEASE CLINICS, and very soon it will be ready for all. As you know, anyone may choose to be in the Early Release group. At the same time, if you have the EARLY RELEASE label in your initial log in window and you do not wish to download the software right now, you simply can wait. If you wish to be removed from this program, please call us and we will help you move back to the regular group.

There are so many new features and improvements within this version, that even when limiting the discussion to the new features, the 3.4 Mini-Manual is almost a hundred pages long!

SPEED:
You will find that praxis 3.4 is faster than Praxis has ever been. In addition, it comes with an automatic Oracle engine script meant to constantly tune up your database to keep it running optimally.

VERY POWERFUL NURSING TASK AGENTS:
They will help you make sure that what you order done, is in fact, done, or you find out why it was not done. This is a great way to document performance in the patient record.

CLINICAL PRACTICE GUIDELINES:
As you will see when you read the new manual, the Praxis CPG's are nothing short of revolutionary, using a dramatically different approach to the transmission of knowledge that does require templates, and respects the right of the provider to practice medicine his or her way.

DRUG CONTRAINDICATION DATABASE
This new add on from the DIT Corporation will keep your drugs up to date and is improved in many areas, including the “Traffic Lights” as you will be happy to read in the manual. The cost for this elective and self upgrading software is 100 dollars per user of the medication database per year (if your nurse consults the database, you need to include her or him as well). This is less than most other companies charge for the same service. You may select who will use it in your clinic, and then pay us accordingly. You will find an order form attached to this document for your convenience. Please fill out the information and simply fax it to us.The DIT agreement is found at the bottom of the new Mini-Manual.

MANY OTHER IMPROVEMENTS:
Please check the Mini-Manual.

CLASSES OVER THE INTERNET
We are planning to start a 3.4 online course to all those who wish to learn how to get the most out of this new version. We will keep you abreast of the dates and times as they become available

We are also moving full speed ahead on making more frequent releases, this time by strictly following your suggestions of what you consider vital to an excellent EMR.

The CCHIT certification has placed Praxis among the 22 accepted EMRs in the country, but by doing so we were forced to deviate from our long standing commitment to work only for our clients and on behalf of our clients. Some of the features that we had to develop (such as the practice guidelines and sophisticated security system) may therefore not seem to you as relevant as other features that we could have been working on. However, we are now both accredited and free to dedicate our time once again to you, our valued clients, and to make releases much more frequent.

Still, you will see so many wonderful new features that you are bound to love the new Praxis!

SUPPORT
Keep your critiques and ideas for development coming. We are moving our entire support group into direct communication with you in the next few weeks, and we are instituting a powerful CRM software to improve our support yet further. We are sure you will be delighted with the results.

INTERFACING:
Remember that we are now focused on INTERFACING with all synergistic products, in particular with regards to billing and laboratory software and prescription transmission programs. If your interface has been left behind, this will be fixed in the next coming weeks. Interfacing is in all our very best interests. We are developing a new technology striving for perfect, transparent interfacing. We are sure that you will be delighted with the results.

USER DISCUSSION FORUM
We are also about to open a Users Discussion Forum that will no doubt be fascinating. It will give you the opportunity to interact with fellow Praxis users, provide and receive suggestions and help us improve your software further than ever.

KNOWLEDGE EXCHANGER
We are extremely close to releasing our very first Knowledge Exchanger, in what will no doubt be a revolutionary improvement in the Concept Processing Technology. In fact, we strongly believe that the Knowledge Exchanger when merged with the Concept Processor will make templates totally obsolete.

Again, thank you for all your wonderful feedback and patience and for your always loyal support!

Warmest Regards,


Richard M. Low, MD
CEO

January 11, 2006

Dear Praxis Clients,

As usual, this upgrade fixes problems found recently. Most importantly, however, Build 14 introduces a far better Online Update, one that will be much more un-intrusive, allowing for nearly painless updates. After this update, all new updates will be very simple.

As you know, the updates are being sent from our server in a manual process that has to be performed on your server and each and every workstation, so that Praxis can run properly.

With the new online update, the very next update will work directly from YOUR server. In fact, ALL YOU WILL NEED TO DO AFTER THIS UPGRADE IS PERFORM THE UPDATE ONCE IN THE SERVER in a process process is many times faster. Most importantly, no one can forget to do the update; it just happens automatically as each user start to use Praxis in the different workstations.

Why the Frequent Updates?
This update mechanism idea suggested early this year by Doctor Brian Uslick, is a brilliant one. In fact, the new Online Update has become the cornerstone to a fascinating new approach in our development of medical software.

As Praxis became larger and more sophisticated, it has became obvious to us that the old fashion method of upgrading to our beta testers group, and then to the general group every few months, would simply not work anymore. This was one reason why upgrades would take so long in the past.

The basic reason for this difficulty is that each new feature generates proportionally more ideas from you, which constantly change our priorities as we learn what is important to you. More importantly, the changes do not always work in the real world the way that we envisioned them in our labs, even after thorough testing. This is OK, provided that we can easily fix any problems that are found.

Now, with increase size of the software and number of new features, the diagnosis of errors becomes more difficult. Without the Online Update, installation problems would literally take hours to resolve. Even if we were 100 times smarter, we would not be capable to accomplish global improvements all at once. The tests that we put the software through have the built in assumptions and biases that a real clinic like yours would not show.

Thus the elegant solution is to make small upgrades frequently, and be very attuned to your feedback after each upgrade. Because so many clinics try each upgrade in early release, excellent feedback is fast in coming. Within a few days, we either find problems we can fix, or we can be certain that the upgrade is ready for general release to all the remaining clinics.

In addition, you decide both, 1) Whether you wish to be an early adopter of these upgrades or wait for others to test them first, and 2) How often you wish to update your Praxis.

However, this works only if the update is not cumbersome! Thus, this update simplifies Online Update mechanism itself. The goal is that when you decide to update, then your whole clinic follows suit effortlessly and fast in a few seconds. All you do is upgrade your server. The rest follows very quickly!

So until now the update happens like this:

Each workstation needs to download the update from ther server.
As of this this update, however, the next updates will be like this:

As you can see, the update happens in the server first, and then each workstation is updated automatically as it is turned on. Much easier, faster and safer!


Feedback
This brings us to the other side of software development: your critical feedback.

We LOVE to hear from you! We view your feedback the way you view the symptoms presented to you by your patients: They are a fascinating challenge for us to develop ever better software. The more you tell us, the better Praxis turns out. Try as we may, we can never be in your shoes. Not only that, but often we cannot even understand the subtleties of your experience. This is why we love to receive complaints, even if they are not that well explained. We need to diagnose the problem from what you tell us. The perfect software would produce no feedback except praises. Imagine the perfect software and compare it what you have. What are the ten things that – if implemented – would make your praxis be much better than today?


Reality Testing
The Concept Processor was a brilliant idea in 1989. However, a brilliant idea plus a dollar buys a cup of coffee. Starting with Praxis 1.0, we have received thousands of critiques from you, and this “groupthink’ is what is what you are seeing today.

The reality is more or less like this:

Developers work in their own world. Their world consists of ones and zeros and hardware constraints. Your world, on the other hand, involves working with patients under tremendous emotional, intellectual, and time pressures, which Praxis is supposed to help resolve. Our goal has to be to link these two worlds as best as can it can be done. Even though some of us have practiced medicine for many years, none of us are currently using Praxis in real practice the way you are. Great software development can only have one purpose, and that is to SERVE YOUR NEEDS 100% all the time.

We are sure that there are things you see in Praxis that make you say: %^$#@%& !!!

Even we cannot believe that our developers did something or other sometimes. Yet, after many years of working in software development, we realize the same thing you have come to realize about some of your patients… It is amazing at times to see very smart patients, who have no idea of the disease process, come up with the craziest ideas and solutions. Yet, your patients are not stupid, they are living in a different experiential reality than you are.

Likewise, Ones and zeros, and a live medical practice have to come together in order for the software to approach greatness. The purpose of the software is to make you enjoy your practice of medicine, save you time, effort and money, and help you practice better medicine. Software IS ALWAYS BIASED by design, and Praxis tries its best to be biased on your side as the practicing physician or as the assistant. We work for you and your practice and for no one else! We need to look a this from your own perspective.

These are lofty goals, but only you know how you use Praxis in your practice. So then this two-way communication. Please don’t assume anything. Think of us as really stupid, and you will be more right than wrong :-)

Keep in mind that after a while, you may get “adjusted” to the nuances of Praxis, and this is bad. That is why your first impression is the most important one. Praxis should work the way you do and never the other way around! We can and will improve things for you if we hear from you!As simple note here to support@praxisemr.com is all it takes!.. and now that the updates will be so very simple to accomplish, these improvements will continue to speed up. In fact, in our next release, you will see we shaved off another 5 seconds to the opening and handling of the patient record. The new retrospective Query engine is also almost ready, resulting in a much more powerful query library that will work far better (thank you for your feedback on this, by the way!)

Many other features will be released in the with the next upgrade in just a couple of more weeks, and that is why this release is so important.

Interfaces:
I you still have interface problems, please let us know. Otherwise , we assume that no news is good news. Simply drop of a line saying : These interfaces are still not working well… and we will take it from there.

Faxing from Praxis
With Winfax, this should be pretty straighforward. Simply add the Winfax driver to your Praxform, and if you ever send something out, then the Winfax window opens and requests the phone number. We are also working on an automatic sender where even this will not be needed and the fax will happen totally Automaticly.

Zeta Fax for some reason is still having problems, and we are still working on that software at the moment.


CONCLUSION
Upgrade 14 is should be a very stable software, but as usual, we will keep it in early release for a few more days and then release it to the rest of you. You can always decide whether you wish to be in the early adopter group or not.

Thank you for your wonderful support! Remind your colleagues not using Praxis to download our new Praxis demo from www.praxisemr.com/demo

HAVE A GREAT 2006! This will be the year that Praxis becomes everything you always dreamed about in your EMR.

Warmest Regards,

Richard M. Low, MD
CEO

PRAXIS 3.4 UPDATE

**************************
Please remember to do a backup before performing any update!
**************************


Dear Praxis Clients,

Many thanks to all of you once again for your feedback.

This latest update is hopefully the last release of Version 3.4 before we release the software to our entire Praxis customer base. We thank all our 3.4 clients for your wonderful support throughout this CCHIT Upgrade. As you know, CCHIT demanded major re-engineering from Praxis to qualify our software. Normally, the upgrades are far more physician-centric and far more useful and less complicated.

The current upgrade consists of several improvements of features that were still not working perfectly, particularly in the medications section and the Fast Rx section. It is based on the invaluable feedback we received from you. We think you will be happy with the results!


NEW CPT/ICD Codes

In addition, the 2007 CPT and ICD codes have been released. If you purchased Praxis EMR in the last year, your license is included in your original price, however, please send an email to support@praxisemr.com to reset your license. A temporary license will advise you to do so right away so as not to shut off the database. In addition, The DIT Drug dataqbase license is also included for those of you who have purchased Praxis in the last year, and for those of you who have already paid. The drug contraindication data is automatically improved every quarter. Again, please email us at support@praxisemr.com

ATTENTION 2.19 Clients :
If you have not upgraded to Praxis Version 3 yet, this is probably your last chance to do so. After many months, we have developed a new 2.19 to 3.4 interface. Please upgrade now by contacting our support group at 818-592-2900. The new interface is now found within Praxis 3.4, but call us anyway as we need to help you upgrade.

Why So Many Updates?

The practice of medicine is a complex art as well as a science, and each one of you is a teacher as well as a developer of Praxis EMR. With hundreds of clinics, Praxis learns from you in more ways than one. The good news is that we do listen and we listen carefully to develop for you, and you only.

However, for those of you who do not wish so many updates, there is also an opt-out option. If you would not like to participate in the upgrade then simply download the PrxOnlineUpdateFalse.reg and execute it once on your server and in all the workstations. Praxis will then stay in the current version. Alternatively, if you wish to participate in improving Praxis, then select the PraxisOnlineUpdateTrue.reg file and execute it once on your server and on every workstation. You will immediately see the label 'Early Release' on your initial window. However, to share with us problems or ideas with Praxis, you need to be in the early release group, because we can always improve the future, but no one can improve the past!

It is extremely likely that any problem you may be experiencing has already been fixed in the last version. If the problem is causing you any difficulty, simply upgrade to the new version. If the problem persists, please show us, and we will fix it immediately for you and for everyone else!

Thank you for being such great clients. Praxis is getting continually better thanks to your feedback.

Richard M. Low, MD
CEO PRAXIS 3.4 UPDATE - PATIENT DUPLICATE RECORD MERGER

**************************
Please remember to do a backup before performing any update!
**************************


Dear Praxis Clients,

IN addition to the improvements found in yesterday's note to you, this new release includes a Patient Duplicate Record Merger.

Please see attached.

Thank you for all your support!


Richard M. Low, MD
CEO